Fat Transplantation has become a very popular and intriguing topic over the past few months. More and more patients enter our office with questions about whether or not fat transplantation may be a solution for their volume loss and signs of aging. Media coverage has also exploded onto this topic, touting it as a “new” and successful procedure.
The media is correct. In the hands of an experienced cosmetic plastic surgeon, we are indeed seeing a nice, long lasting result for those who have lost volume in areas such as the face, and breast. However, this procedure is hardly new to those physicians on the leading edge in a cosmetic surgery practice. In fact, fat transplantation has been in high use for decades as it parallels the beginning of liposuction. I have been utilizing fat transplantation in my practice since the 1980’s.
So, why has the media suddenly taken interest in this procedure? The interest and notoriety of procedures is a little bit like that of celebrities-it comes and goes, has peaks and valleys and is likely related to news media events that are highly popular. Such is the current interest in fat transplantation. The primary reason for the resurgence of interest in fat transplantation has to do with changes in technique. With a slightly better understanding of stem cell research and years of technique evolution, this procedure continues to be refined.
In the beginning, fat transplantation was done by placing moderate to large amounts of fat into different areas of the body. The results were okay, that is, there was some fat that survived this rudimentary method of transplantation; however, the results were not consistent enough to be able to accomplish wide acceptance by both physicians and patients.
In the late 90’s, popularization of fat transplantation in the medical literature in general and cosmetic surgery in particular revolved around the idea that for fat transplantation to be successful the fat needed to be placed in very small amounts in multiple areas. That meant that fat needed to be injected with instruments that created very little bleeding. Therefore, we used blunt cannulas for the injections. The fat needed to be placed in very minute amounts into many areas, and so there was the development of a technique whereby multiple passes were created in one area, depositing very small amounts of fat in each one of those passes. This resulted in a more successful and consistent outcomes for all experienced practitioners.
Today, some questions still remain, like “Does the fat need to be prepared prior to the injection or not?” This question is still to be resolved in the future. Most practitioners today will harvest fat from a common area, mainly stomach and/or thighs, will prepare it by centrifuge at low speed, that is, it will be placed in rotation separating the serum from the fat. Once this is accomplished, the serum is discarded. The fat is placed into very small syringes and then injected as soon as possible. While the fat can be under deep freeze and injected in the future, it is much more effective; that is the rate of “take” is much higher, when the fat is injected immediately.
One needs to place a lot of fat in the area to be remodeled because approximately 70% of the fat will be reabsorbed by the body and only 30% of the fat will take and be part of the graft. Fat is primarily used to fill out areas of the body and face by taking fat from an area that has excess, preparing it and utilizing it to fill out areas that need volume or rejuvenation. Fat transplantation is most commonly used to create a more shapely body region such as the buttocks or breasts. Fat is extremely useful in filling the contours of the face that deflate with age. Such facial areas may be deflated, sagging cheeks, corners of the mouth, lips, or smile lines. It’s most successful in removing divots, depressions and over a period of time, successful in remodeling wrinkling.
More recently, studies are showing that there seems to be an effect from fat transplantation, which is beyond filling depressed areas. Fat contains stem cells, which are primary cells that are able to regenerate tissue. These studies indicate that when fat is placed underneath the skin, it can remodel the skin, reversing signs of aging and creating a more uniform result.
Because the fat is grafted using the patient’s own fat, the risk of allergic reaction is eliminated. Fat transplantation is done both under local anesthesia and under sedation or general anesthesia. Patients can expect bruising and swelling for 7-10 days, and patients can expect to return back to work in 7-10 days. While to some people this may be a new procedure, it has been part of the arsenal of procedures that the plastic and cosmetic surgeon has had at his or her disposal for over 25 years. We are very encouraged by advances made with this procedure over the years, as it is a reliable and cost effective option for our patients.
G.D. Castillo M.D., Fat Transplantation Expert
G. D. Castillo, M.D.
COSMETIC PLASTIC SURGERY
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